Observed hospital management involvement in the implementation of clinical governance activities in two South African provinces

Background: Healthcare managers play a critical role in promoting continuous quality improvement and maintaining consistent standards of care. South Africa’s public hospital management system has been characterised as fragmented; however, increased managerial involvement in clinical governance offers an opportunity to strengthen clinical–administrative leadership and improve the quality of care. This study aims to determine the extent of hospital management involvement and the perceived importance of such involvement in the implementation of clinical governance activities in public hospitals in the Eastern Cape and Mpumalanga provinces.
Methods: A quantitative cross-sectional study was conducted in four public hospitals: St. Elizabeth and Nelson Mandela Academic hospitals in the Eastern Cape, and Themba and Rob Ferreira hospitals in Mpumalanga. Participants included nurses, medical doctors, pharmacists, dentists, and allied health professionals. A stratified random sample of 720 participants was calculated, of whom 377 responded (233 from the Eastern Cape and 144 from Mpumalanga). Data were analysed using STATA version 18.
Results: Nursing operations managers (70.8%), non-specified health professionals (64.9%), and nursing service managers (64%) demonstrated the highest levels of engagement in clinical governance activities. In contrast, participation among non-clinical managers was low, including finance managers (14.6%), information managers (14.4%), corporate service managers (12.1%), and chief executive officers (8.4%). Clinical managers were reported as not participating at all in 5.7% of cases. Despite these differences, 90% of respondents considered hospital management involvement important for implementing clinical governance.
Conclusions: Hospital management involvement in clinical governance was evident and considered important in both provinces. However, the lower participation of non-clinical managers indicates an implementation gap, highlighting the need for targeted training to improve understanding and effective participation in clinical governance.
Keywords: Clinical Governance, Hospital Management, Clinical Staff, Clinical Governance Activities, Quality Clinical Care.